Personal insight may predict future health events for older people

Monash University

An older person’s perceptions about their health – known as health-related quality of life (HRQoL) – may predict their health in the future, new Monash research shows.

Four studies led by researchers at the Monash School of Public Health and Preventive Medicine found that self-perceptions of health were a valuable tool in helping to identify older adults at risk of death and adverse health events, and could assist doctors in patient care.

In the latest study, researchers found older adults who reported a decline in physical aspects of quality of life over almost five years were 51 per cent more likely to develop cardiovascular disease compared to those who reported high physical HRQoL. A consistently low physical HRQoL trajectory was associated with greater likelihood of dying compared to the highest ranking group.

This study, published in American Heart Journal Plus: Cardiology Research and Practice, marks the first time researchers have established a link between declining physical HRQoL trajectory and the risk of cardiovascular disease over an extended period of time.

Researchers analysed self-reported quality of life data in 16, 871 participants in the ASPREE (ASPirin in Reducing Events in the Elderly) trial and tracked their health for a further two years in the follow-up ASPREE-XT study. Study participants were mostly aged over 70 years, healthy and living independently in Australia and the USA at enrolment into ASPREE. Participants reported HRQoL – a method to rate aspects of their physical, psychological and social (mental) wellbeing – at entry into the study and annually for an average of 4.7 years.

Sixty-seven per cent of participants consistently rated their physical HRQoL in the high category; 13 per cent as intermediate, 14 per cent as declining and 7 per cent as low.

Earlier, in separate analyses of ASPREE data that examined HRQoL at the beginning of the study only, researchers found:

  • Better physical HRQoL at enrolment was associated with lower risks of cardiovascular disease (14 per cent), cognitive decline (6 per cent) and death (17 per cent) over an average of 4.7 years.

  • Higher mental HRQoL at study entry was associated with lower risks of cognitive decline (12 per cent) and dementia (15 per cent) over the same period.

The strong correlation between low physical HRQoL at enrolment and cardiovascular disease and death led researchers to the latest analysis, tracking participants’ health perceptions (i.e. HRQoL) over an extended period of almost five years.

Lead researcher, PhD candidate Aung Zaw Zaw Phyo said:

“The studies indicate that self-reported HRQoL could be used to supplement objective measures, such as weight, blood pressure and cholesterol in outpatient health assessments and care.

“Our research strengthens the importance of HRQoL as a predictive measure of cardiovascular disease, dementia, cognitive decline and deaths among older adults living independently in later life.”

The studies were reported in papers published in four separate journals:

The studies were undertaken with Monash researchers Dr Rosanne Freak-Poli and Associate Professor Joanne Ryan, together with Associate Professor David Gonzalez-Chica and Professor Nigel Stocks from Adelaide Medical School (University of Adelaide), and co-investigators from the University of Tasmania and Curtin University (Australia), the University of Edinburgh (UK), and Rush University Medical Center and Hennepin HealthCare Research Institute (United States).

Aung Zaw Zaw Phyo works in the Biological Neuropsychiatry and Dementia research unit at Monash University School of Public Health and Preventive Medicine, and was funded by a Monash Graduate Scholarship and Postgraduate Publications Award. Dr Rosanne Freak-Poli was co-funded by the Heart Foundation.

doi.org/10.1016/j.ahjo.2022.100117

doi.org/10.1016/j.ijcard.2021.07.004

DOI: 10.3233/JAD-201349

doi.org/10.1007/s11136-020-02723-y

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